Central Line Related Blood stream Infection (CLR-BSI): Difference between revisions

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==Central Line Related Blood Stream Infections (CLR-BSI)==
{{PreICD10 dx
| NewDxArticle = Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
}}
{{DX tag |Infection | Medical Problem| Central Line Related Blood stream Infections | See: [[UPL]] (Universal Pathogen List) | 8600 - Central Line Related Blood stream Infections | No | 0 | '''''Critical Care and Medicine''''' |Currently Collected | Code added Jan 1996|}}


'''The Case for Preventing Central Venous Catheter related Bloodstream Infections.'''
== Criteria ==
* Central Venous Catheters (CVCs) are being used increasingly in the inpatient and outpatient setting to provide long-term venous access. CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible. Infection may spread to the bloodstream and hemodynamic changes and organ dysfunction (severe sepsis) may ensue, possibly leading to death. Approximately 90% of the catheter-related bloodstream infections (CR-BSIs) occur with CVC.
Have been moved to [[Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)]] in prep for ICD10, please see there.  
* Forty-eight percent of intensive care unit (ICU) patients in the U.S. have central venous catheters, accounting for 15 million central-venous-catheter-days per year in U.S.-based ICUs. Studies of catheter-related bloodstream infections that control for the underlying severity of illness suggest that mortality attributable to these infections is between 4% and 20%. Thus, it is estimated that 500 to 4000 U.S. patients die annually due to bloodstream infections.
* In addition, nosocomial bloodstream infections prolong hospitalization by a mean of 7 days.Attributable cost per bloodstream infection is estimated to be between US $3,700 and $29,000. There are no equivalent Canadian figures for burden of illness. (as per literature).  


*'''Purpose'''
== Related Articles ==
**To identify the incidence of Central Venous Line Related Infections within the WRHA ICU's.
{{Related Articles}}
**The monitoring of the incidence over time will identify the magnitude of the problem within a specific area or unit and will enable comparisons between selected ICU's across Canada (Canadian Collaborative - Safer Health Care Now).
**This should lead to the review of practices occuring at the time of insertion as well as the care processes relating to the maintenance of the catheter dressings.


*'''GOAL'''
[[Category: Central lines (old)]]
**Eliminate this preventable patient harm.
 
==Criteria for Central Line Related Blood stream Infections (CLR-BSI)==
Laboratory confirmed bloodstream infection must meet at least '''one''' of the following criteria and have occurred in the ICU or within 48 hours of leaving the ICU:
*'''Criterion 1:'''
Patient has a recognized pathogen cultured from '''one or more''' blood cultures and the organism cultured from '''blood is not related''' to an '''infection at another site'''.
*'''Criterion 2:'''
Patient has at least '''one''' of the following signs or symptoms:
*fever (>38 C)
 
'''OR'''
 
*chills
 
'''OR'''
 
*hypotension
 
'''OR'''
 
*Signs of infection of catheter insertion site/tunnel
 
'''AND'''
 
* at least one of the following (A or B) below:
 
a.) Common skin commensal (contaminant) is cultured from '''two or more''' blood cultures drawn on separate occasions.  (e.g.  diphtheriods, Bacillus sp., Propionibacterium sp., coagulase-negative staphylococci, or micrococci).
    '''OR'''
b.) Common skin commensal (comtaminant) is cultured from at least '''one''' blood cultures from a patient with an intravascular line. (e.g.  diphtheriods, Bacillus sp., Propionibacterium sp., coagulase-negative staphylococci, or micrococci).
    '''AND'''
physician institutes appropriate antimicrobial therapy.
 
==Defintion of Terms==
==='''CL''' means'''Central Line''' ===
A CL is a vascular access catheter that passes through or has a tip ending at or close to the heart or in one of the great vessels.
 
'''Great vessels''' include:
*aorta
*pulmonary artery
*superior vena cava
*inferior vena cava
*brachiocephalic vein
*internal jugular vein
*subclavian vein
*external iliac vein
*commom femoral vein
 
'''Central Lines''' include:
*subclavian vein catheter
*internal jugular vein catheter
*PCII (Peripherally Inserted Central Catheter)
*Swan-Ganz (pulmonary artery) catheter
*Brovic
*Groshong
*Hickman
*Dialysis catheter
*introducer for temporary pacing wire
 
'''Not''' counted as Central Lines:
*arterial catheters inserted into an artery
*pacemaker wire-permanent
 
===BSI means '''blood stream infection===
 
The Definition of bloodstream infections established here are not to be construed as technical medical definitions of BSI, but only as a definition necessary to establish a reporting requirement.
 
'''Criteria for Blood stream Infection (BSI)''':
* At least one of the following:
'''A.''' at least '''one blood culture''' result includes a pathogenic organism
'''OR'''
 
'''B.''' at least '''two blood cultures''' results from specimens obtained at different times or from specimens drawn at different phlebotomy sites, e.g., left arm and right arm, within a 2 day period include the same type of common skin commensal organism.
'''OR'''
 
'''C.''' at least '''one blood culture'''e result includes a common skin commensal organism
*'''AND'''
** '''antibiotic''' treatment effective against that organism was started on the day that the culture was collected and was continued for greater than 3 days.
 
==Common skin commensal==
*Common skin commensal means microorganisms that are commonly found on the skin and often indicate contamination of the blood culture media rather than identification of a pathogenic organism when identified in blood culture tests.  these include coagulase negative staphylococci, proprionbacterium species, corynebacterium species, diphtheroids, bacillus species and mirococcus species.
 
==Central Line Days (CLD's)==
 
 
 
 
====Notes====
* ICU associated BSI: BSI is not present on admission to ICU.  The patient must have been in the ICU for 48 hours for the BSI to be considered ICU associated, unless compelling evidence suggests the infection was ICU associated.
* BSI onset during ICU stay or within 48 hours of leaving the ICU.
 
 
{{Discussion}}
(the antibiotic part of the definition is problematic because:
* it would exclude a patient where, after the culture comes back, it is found out that the antibiotic was not in fact effective.
* it might loose a patient whose antibiotic is started but for whatever reason is discontinued.
* are there, or are there anticipated to be, any antibiotics whose course will legitimately be less than 3 days
* it would exclude patients who are already on an antibiotic and remain on the same one due to a BSI)
 
==Discussion==
 
#need to attached or link the rest of the teaching package for this project. [[User:TOstryzniuk|TOstryzniuk]] 18:48, 2 July 2008 (CDT)
 
 
 
{{stub}}
[[User:TOstryzniuk|TOstryzniuk]] 19:42, 26 June 2008 (CDT)
[[Category: Data Collection Guide]]
[[Category: Diagnosis Coding]]
[[Category: Questions]]
[[Category:Special_Projects]]

Latest revision as of 21:33, 2018 December 30


Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)

Click Expand to show legacy content.


edit dx infobox
Category/Organ
System:
Category:Infection (old)

Type:

Category: Medical Problem (old)

Main Diagnosis: Central Line Related Blood stream Infections
Sub Diagnosis: See: UPL (Universal Pathogen List)
Diagnosis Code: 8600 - Central Line Related Blood stream Infections
Comorbid Diagnosis: No
Charlson Comorbid coding (pre ICD10): 0
Program: Critical Care and Medicine
Status: Currently Collected
Start Date: Code added Jan 1996

Criteria

Have been moved to Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI) in prep for ICD10, please see there.

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